Radiotherapy Applications Research Articles

Functional-structural reorganisation of salivary glands in oncological pathology: A mini-review

. Dysfunctions of salivary glands during the treatment of benign and malignant tumours are a widely diagnosed problem among oncology patients. This study aimed to investigate the disruption of the structure of salivary glands as a result of the treatment of oncological diseases and methods for their correction and elimination. 39 scientific papers were analysed. Methods of search, comparison, systematisation, and combination of the results of the conducted studies were used. The destructive effect of chemo- and radiotherapy and the treatment of malignant tumours by increasing the body’s overall temperature on the structure of salivary glands in the experiment was proven. The influence of low intensity ultrasound on the submandibular gland demonstrates its tissues’ high adaptive and regenerative properties. Data from clinical studies on the correction and elimination of salivary gland dysfunctions in oncological patients showed an ambiguous result. The simultaneous application of photobiomodulation and radiotherapy in patients with head and neck tumours significantly improves organ function: it stimulates salivation, regulates saliva composition, controls the redox mechanism of salivary glands, and locally eliminates inflammation. A slight compensation of the mineralising function of saliva was found with substitution therapy using biologically active components and a remineralising agent in children with malignant tumours undergoing chemotherapy. A positive effect of betanechol and vitamin E in protecting salivary glands during the treatment of head and neck cancer with radiotherapy has been noted, which consists of improving the structure and function of the glands in the long term and is the same in women and men. Studies of vitamin C intake after radioiodine therapy in patients with head and neck cancer have shown its insufficient restorative effect on the quantitative and qualitative composition of saliva. The results of this review can serve as a basis for an accurate assessment by oncologists of salivary gland damage and the pathogenesis of their dysfunctions as a result of cancer therapy, provide an opportunity to reconsider existing views on the problem, develop new methods for preventing and treating these complications, and improve the quality of life and recovery process for patients

Mathematical analysis of FLASH effect models based on theoretical hypotheses.

Clinical applications of FLASH radiotherapy require formulas to describe how the FLASH radiation features and other related factors determine the FLASH effect. Mathematical analysis of the models can connect the theoretical hypotheses with the radiobiological effect, which provides the foundation for establishing clinical application models. Moreover, experimental and clinical data can be used to explore the key factors through mathematical analysis. 
Approach: We abstract the complex models of the oxygen depletion hypothesis and radical recombination-antioxidants hypothesis into concise mathematical equations. The equations are solved to analyze how the radiation features and other factors influence the FLASH effect. Then we propose methodologies for determining the parameters in the models and utilizing the models to predict the FLASH effect.
Main results: The formulas linking the physical, chemical and biological factors to the FLASH effect are obtained through mathematical derivation of the equation. The analysis indicates that the initial oxygen concentration, radiolytic oxygen consumption and oxygen recovery are key factors for the oxygen depletion hypothesis and that the level of antioxidants is the key factor for the radical recombination-antioxidants hypothesis. According to the model derivations and analysis, the methodologies for determining parameters and predicting the FLASH effect are proposed: the criteria for data filtration; the strategy of hybrid FLASH and conventional dose rate (CONV) irradiation to ensure the acquisition of effective experimental data across a wide dose range; pipelines of fitting parameters and predicting the FLASH effect.
Significance: This study establishes the quantitative relationship between the FLASH effect and key factors. The derived formulas can be used to calculate the FLASH effect in future clinical FLASH radiotherapy. The proposed methodologies guide to obtain sufficient high-quality datasets and utilize them to predict FLASH effect. Furthermore, this study indicates the key factors of FLASH effect and offers clues to further explore the FLASH mechanism.

Cell Death Mechanisms in Human Cancers: Molecular Pathways, Therapy Resistance and Therapeutic Perspective

A prominent cause of death among patients is cancer that can result from somatic mutations and exposure to environmental factors, among others. The treatment of cancer has been possible through the application of chemotherapy and radiotherapy that mainly mediate cell death and DNA damage. However, the tumor cells are able to induce the alternative molecular pathways to enhance their survival and mediate resistance to conventional therapeutics. The dysregulation of cell death pathways can significantly improve the therapy resistance in tumors and enhance their progression. Therefore, present review has been dedicated into understanding the abnormalities in cell death pathways. The induction of apoptosis through intrinsic and extrinsic pathways has been of importance in cancer therapy and the apoptosis inhibition through Bcl-2 and XIAP upregulation can mediate drug resistance. Moreover, autophagy has shown tumor-promoting and tumor-suppressing roles in cancer. Both inhibition and induction of autophagy can change tumorigenesis. Necroptosis is another cell death that has some similarities with apoptosis such as involvement of caspase-8 in its regulation. Ferroptosis is an iron-dependent cell death that reduces tumorigenesis and can be also regulated autophagy. The induction of immunogenic cell death and pyroptosis in the tumor cells can affect the immune system for cancer therapy. In addition to phytochemicals and small molecules introduced for the regulation of cell death mechanisms in cancer, the nanoparticles have been also applied to facilitate cell death in tumor treatment.

Thermoluminescence studies of Dy-doped BaAlF5 nanophosphor for radiotherapy application

Thermoluminescence studies of Dy-doped BaAlF5 nanophosphor for radiotherapy application

Radiation-induced DNA damage by proton, helium and carbon ions in human fibroblast cell: Geant4-DNA and MCDS-based study

Background. Radiation-induced DNA damages such as Single Strand Break (SSB), Double Strand Break (DSB) and Complex DSB (cDSB) are critical aspects of radiobiology with implications in radiotherapy and radiation protection applications. Materials and Methods. This study presents a thorough investigation into the effects of protons (0.1–100 MeV/u), helium ions (0.13–100 MeV/u) and carbon ions (0.5–480 MeV/u) on DNA of human fibroblast cells using Geant4-DNA track structure code coupled with DBSCAN algorithm and Monte Carlo Damage Simulations (MCDS) code. Geant4-DNA-based simulations consider 1 μm × 1 μm × 0.5 μm water box as the target to calculate energy deposition on event-by-event basis and the three-dimensional coordinates of the interaction location, and then DBSCAN algorithm is used to calculate yields of SSB, DSB and cDSB in human fibroblast cell. The study investigated the influence of Linear Energy Transfer (LET) of protons, helium ions and carbon ions on the yields of DNA damages. Influence of cellular oxygenation on DNA damage patterns is investigated using MCDS code. Results. The study shows that DSB and SSB yields are influenced by the LET of the particles, with distinct trends observed for different particles. The cellular oxygenation is a key factor, with anoxic cells exhibiting reduced SSB and DSB yields, underscoring the intricate relationship between cellular oxygen levels and DNA damage. The study introduced DSB/SSB ratio as an informative metric for evaluating the severity of radiation-induced DNA damage, particularly in higher LET regions. Conclusions. The study highlights the importance of considering particle type, LET, and cellular oxygenation in assessing the biological effects of ionizing radiation.

Paediatric Anatomical Models in Radiotherapy Applications

Anatomical models have key applications in radiotherapy, notably to help understand the relationship between radiation dose and risk of developing side effects. This review analyses whether age-specific computational phantoms, developed from healthy subjects and paediatric cancer patient data, are adequate to model a paediatric population. The phantoms used in the study were International Commission on Radiological Protection (ICRP), 4D extended cardiac torso (XCAT) and Radiotherapy Paediatric Atlas (RT-PAL), which were also compared to literature data. Organ volume data for 19 organs was collected for all phantoms and literature. ICRP was treated as the reference for comparison, and percentage difference (P.D) for the other phantoms were calculated relative to ICRP. Overall comparisons were made for each age category (1, 5, 10, 15) and each organ. Statistical analysis was performed using Microsoft Excel (version 16.59). The smallest P.D to ICRP was for Literature (-17.4%), closely followed by XCAT (26.6%). The largest was for RT-PAL (88.1%). The rectum had the largest average P.D (1,049.2%) and the large bowel had the smallest (2.0%). The P.D was 122.6% at age 1 but this decreased to 43.5% by age 15. Linear regression analysis showed a correlation between organ volume and age to be the strongest for ICRP (R2 = 0.943) and weakest for XCAT (R2 = 0.676). The phantoms are similar enough to ICRP for potential use in modelling paediatric populations. ICRP and XCAT could be used to model a healthy population, whereas RT-PAL could be used for a population undergoing/after radiotherapy.

Indirect deformable image registration using synthetic image generated by unsupervised deep learning

Background and purpose3D image registration is now common in many medical domains. Multimodal registration implies the use of different imaging modalities, which results in lower accuracy compared to monomodal registration. The aim of this study was to propose a novel approach for deformable image registration (DIR) that incorporates an unsupervised deep learning (DL)-based generation step. The objective was to reduce the challenge of multimodal registration to monomodal registration. Material and methodsTwo datasets from prostate radiotherapy patients were used to evaluate the proposed method. The first dataset consisted of Computed Tomography (CT)/ Cone Beam Computed Tomography (CBCT) pairs from 23 patients using different CBCT devices. The second dataset included Magnetic Resonance Imaging (MRI)/CT pairs from two different care centers, utilizing different MRI devices (0.35 T MRIdian MR-Linac, 1.5 T GE lightspeed MRI). Following a preprocessing step essential for ensuring DL synthesis accuracy and standardizing the database, synthetic CTs (sCTreg) were generated using an unsupervised conditional Generative Adversarial Network (cGAN). The generated sCTs from CBCT or MRI were then utilized for deformable registration with CT scans. This registration method was compared to three standard methods: rigid registration, Elastix registration based on BSplines, and VoxelMorph-based registration (applied exclusively to CBCT/CT). The endpoints of comparison were the dice coefficients calculated between delineated structures for both datasets. ResultsFor both datasets, intermediary sCT generation provided the highest dice coefficients. Dices reached 0.85, 0.85 and 0.75 for the prostate, bladder and rectum for the dataset 1 and 0.90, 0.95 and 0.87 respectively for the dataset 2. When the sCT were not used, dices reached 0.66, 0.78, 0.66 for the dataset 1 and 0.93, 0.87 and 0.84 for the dataset 2. Furthermore, the evaluation of the impact of registration on sCT generation showed that lower Mean Absolute Errors were obtained when the registration was conducted with a sCT. ConclusionsUsing unsupervised deep learning to synthesize intermediate sCT has led to improved registration accuracy in radiotherapy applications employing two distinct imaging modalities.

Immunoregulatory Engineering of Semiconducting Charge-Reversal Nanoantioxidant for Ameliorating Cancer Radioimmunotheranostics.

Radiotherapy (RT) is a crucial clinical modality for cancer. However, nonselectivity, toxicity to normal tissues, and radio-resistance severely limit RT applications. This study develops a versatile X-ray theranostic nano-antioxidant (XTN) to prevent normal tissues from oxidative damage and induce systematic and robust anticancer immunity. XTN owns NIR-II photoacoustic (PA) imaging properties for precise discrimination of the tumor margin through, thereby improving the accuracy of RT. Additionally, XTN is a nano-antioxidant to enhance the cell viability of normal cells after irradiation. Most importantly, XTN scavenges reactive oxygen species (ROS) in the TME to preserve the stimulatory activity of released high mobility group protein B1 to dendritic cells (DCs) and recover T cells' immune function. Meanwhile, XTN achieves charge-reversal specifically releasing an immunomodulator (demethylcantharidin, DMC) in the acidic TME. Moreover, the specifically released DMC inhibits protein phosphatase-2A activity and reduces regulatory T cell (Treg) differentiation. In the bilateral 4T1 tumor model, XTN-mediated radioimmunotherapy remarkably boosts a systemic antitumor immune response and induces durable immunological memory against tumor growth.

Application of Palliative Hemostatic Radiotherapy in Canine Unresectable Oral Melanoma: A Case Report

A 9-year-old castrated male Schnauzer dog, weighing 11.6 kg, presented with a persistent hemorrhagic oral mass. An oral examination revealed a right maxillary oral mass characterized by continuous bleeding, halitosis, and severe pain. A cytological examination led to a provisional diagnosis of malignant melanoma, and, despite the option of aggressive surgery, the owner declined. The blood analysis indicated severe hemorrhagic anemia (hematocrit, 18.2%) requiring a blood transfusion. The patient underwent volumetric modulated arc therapy (VMAT) as part of a palliative radiation protocol, receiving six fractions of 6 Gy weekly for hemostasis and clinical improvement. The hemorrhaging ceased after the second fraction, with a subsequent rise in the hematocrit levels and the resolution of the anemia. Additionally, the intake increased following the second fraction, and effective pain management was achieved in the fourth fraction. Following the last fraction, computed tomography revealed a 20% reduction in the tumor size. This case highlights the potential use of radiotherapy for hemostasis in cases of inoperable hemorrhagic oral melanoma and represents the first report on the application of hemostatic radiotherapy in dogs.

Thermal, dosimetric and thermo-mechanical characterization of ABS and PLA polymer materials via plastic injection molding for innovative bolus materials in radiotherapy applications

The impact of radiation on polymer materials, and consequently on their mechanical and physical properties, is a burgeoning field of research. This research assesses the dosimetric, mechanical, and thermal characteristics of Acrylonitrile Butadiene Styrene (ABS) and Polylactic Acid (PLA) materials developed through plastic injection molding as possible alternatives to commercial bolus used in radiotherapy. The materials were thoroughly compared with the commercial bolus material, EXAFLEX, by various tests such as Hounsfield Unit (HU) Analysis, Radiation Transmittance, Thermogravimetric Analysis (TGA), Thermomechanical Analysis (TMA), and Fourier Transform Infrared Spectroscopy (FTIR). The research indicates that ABS and PLA materials have similar radiological qualities to EXAFLEX, showing constant surface and accumulation area doses. Minor differences are seen deeper inside the phantom, indicating a stable tissue equivalency. ABS demonstrated strong resistance to radiation-induced chemical modifications, but PLA exhibited susceptibility to molecular changes. The TMA findings showed that radiation caused a decrease in softening temperatures and an increase in the coefficient of thermal expansion for both ABS and PLA, indicating changes in their thermal stability and mechanical characteristics after irradiation. The study highlights the potential of ABS and PLA materials made through plastic injection molding as efficient and safety substitutes for commercial bolus materials, particularly for large area irradiation. This requires more research into their clinical uses and consequences.

Development and characterization of a Fricke gel dosimeter for precise measurement in low-dose photon fields

In the field of radiation medicine, particularly within radiotherapy applications, radiochromic chemical dosimeters are indispensable tools for dose measurement. This study focuses on the novel development of a radiochromic dosimeter tailored for the precise detection of low-dose radiation, aiming to construct a dosimeter with tissue-equivalent properties suitable for accurately measuring low to medium radiation doses. Utilizing ferrous xylenol orange gel (FXG), we developed two tissue-equivalent dosimeter formulations based on gelatin and polyvinyl alcohol (PVA). Our findings demonstrate that the gelatin-based FXG dosimeter exhibits a robust linear dose-response relationship, facilitating precise dose measurements in the range of 50 to 5000 mGy. Conversely, the PVA-based FXG dosimeter proved effective for dose measurements within a narrower range of 600 to 5000 mGy. Notably, the gelatin-based dosimeter's performance underscores its potential as a versatile tool in radiation detection, promising significant benefits for both medical and industrial applications. This research confirms the efficacy of the Fricke dosimeter gel, demonstrating its linear response across a dose range of 0.05 to 5 Gy, thus establishing a foundation for further advancements in accurate and reliable low-dose radiation monitoring.

Calculation of [formula omitted] and [formula omitted] thick targets neutron yields from particle accelerator-induced nuclear reactions using PHITS code

The double-differential cross-sections, and neutron yields of the 9Be(4He,n)12C and 12C(d,n)13N reactions at various energies, have been calculated. The cross-sections for the consider nuclear reactions were obtained using PHITS code based on Monte Carlo method. The calculated data were validated against the available experimental data with varying agreement up to 30MeV. We have suggested the most suitable reaction, at certain energies, for better neutron yield and hence radiotherapy applications.

Comprehensive dosimetric characterization of novel silicon carbide detectors with UHDR electron beams for FLASH radiotherapy.

The extremely fast delivery of doses with ultra high dose rate (UHDR) beams necessitates the investigation of novel approaches for real-time dosimetry and beam monitoring. This aspect is fundamental in the perspective of the clinical application of FLASH radiotherapy (FLASH-RT), as conventional dosimeters tend to saturate at such extreme dose rates. This study aims to experimentally characterize newly developed silicon carbide (SiC) detectors of various active volumes at UHDRs and systematically assesses their response to establish their suitability for dosimetry in FLASH-RT. SiC PiN junction detectors, recently realized and provided by STLab company, with different active areas (ranging from 4.5 to 10mm2) and thicknesses (10-20µm), were irradiated using 9MeV UHDR pulsed electron beams accelerated by the ElectronFLASH linac at the Centro Pisano for FLASH Radiotherapy (CPFR). The linearity of the SiC response as a function of the delivered dose per pulse (DPP), which in turn corresponds to a specific instantaneous dose rate, was studied under various experimental conditions by measuring the produced charge within the SiC active layer with an electrometer. Due to the extremely high peak currents, an external customized electronic RC circuit was built and used in conjunction with the electrometer to avoid saturation. The study revealed a linear response for the different SiC detectors employed up to 21Gy/pulse for SiC detectors with 4.5 mm2/10µm active area and thickness. These values correspond to a maximum instantaneous dose rate of 5.5 MGy/s and are indicative of the maximum achievable monitored DPP and instantaneous dose rate of the linac used during the measurements. The results clearly demonstrate that the developed devices exhibit a dose-rate independent response even under extreme instantaneous dose rates and dose per pulse values. A systematic study of the SiC response was also performed as a function of the applied voltage bias, demonstrating the reliability of these dosimeters with UHDR also without any applied voltage. This demonstrates the great potential of SiC detectors for accurate dosimetry in the context of FLASH-RT.

Failure Mode and Effects Analysis Application in External Beam Radiotherapy

Background: Radiotherapy is a medical procedure with potential high risk to harm patients. In order to reduce that risk and create a workflow safe for patients, prospective analysis tools are used. Failure modes and effect analysis (FMEA) is one such tool, used to evaluate potential risks. As FMEA originated from industry, there is a constant effort to adjust FMEA methodology for use in radiotherapy. This has caused a variety of approaches and inhomogeneous practices. Purpose: To investigate the current practice of FMEA in external beam radiotherapy and to propose a more standardised approach. Materials and Methods: The search was performed in PubMed, Ovid and Embase databases, resulting in 312 articles retrieved. Using PRISMA methodology the number of unique articles meeting inclusion and exclusion criteria was reduced to a total of 35, containing 38 analyses. The data on FMEA methodology implemented, scope of analysis, expert team composition, number of failure modes (FM) detected, relative priority number (RPN) threshold, number of FM exceeding the threshold, minimum, maximum and mean RPN, RPN calculation method and risk mitigation strategies were selected as important properties of FMEA. Results: Data retrieved showed large variation in how FMEA is conducted. There is a considerable underreporting of minimum and mean RPN values. Large variations in RPN threshold value selection were also observed. Two different approaches to RPN calculation procedure were reported, and it is unclear what the best practice is. Expert teams were assembled according to the guidelines, but the optimal number of members is unclear. The vast majority of risk mitigation measures were applied directly, without the use of systematic tools. Conclusion: FMEA is a well-established and widely used tool for prospective risk assessment in radiotherapy. As a result of this analysis, recommendations for more standardized approaches were proposed. Possible additional research goals were proposed in order to provide evidence for best practice in some areas of FMEA.

CERN-based experiments and Monte-Carlo studies on focused dose delivery with very high energy electron (VHEE) beams for radiotherapy applications

Very High Energy Electron (VHEE) beams are a promising alternative to conventional radiotherapy due to their highly penetrating nature and their applicability as a modality for FLASH (ultra-high dose-rate) radiotherapy. The dose distributions due to VHEE need to be optimised; one option is through the use of quadrupole magnets to focus the beam, reducing the dose to healthy tissue and allowing for targeted dose delivery at conventional or FLASH dose-rates. This paper presents an in depth exploration of the focusing achievable at the current CLEAR (CERN Linear Electron Accelerator for Research) facility, for beam energies >200 MeV. A shorter, more optimal quadrupole setup was also investigated using the TOPAS code in Monte Carlo simulations, with dimensions and beam parameters more appropriate to a clinical situation. This work provides insight into how a focused VHEE radiotherapy beam delivery system might be achieved.

First in vitro measurement of VHEE relative biological effectiveness (RBE) in lung and prostate cancer cells using the ARES linac at DESY

Very high energy electrons (VHEE) are a potential candidate for radiotherapy applications. This includes tumours in inhomogeneous regions such as lung and prostate cancers, due to the insensitivity of VHEE to inhomogeneities. This study explores how electrons in the VHEE range can be used to perform successful in vitro radiobiological studies. The ARES (accelerator research experiment at SINBAD) facility at DESY, Hamburg, Germany was used to deliver 154 MeV electrons to both prostate (PC3) and lung (A549) cancer cells in suspension. Dose was delivered to samples with repeatability and uniformity, quantified with Gafchromic film. Cell survival in response to VHEE was measured using the clonogenic assay to determine the biological effectiveness of VHEE in cancer cells for the first time using this method. Equivalent experiments were performed using 300 kVp X-rays, to enable VHEE irradiated cells to be compared with conventional photons. VHEE irradiated cancer cell survival was fitted to the linear quadratic (LQ) model (R2 = 0.96–0.97). The damage from VHEE and X-ray irradiated cells at doses between 1.41 and 6.33 Gy are comparable, suggesting similar relative biological effectiveness (RBE) between the two modalities. This suggests VHEE is as damaging as photon radiotherapy and therefore could be used to successfully damage cancer cells during radiotherapy. The RBE of VHEE was quantified as the relative doses required for 50% (D0.5) and 10% (D0.1) cell survival. Using these values, VHEE RBE was measured as 0.93 (D0.5) and 0.99 (D0.1) for A549 and 0.74 (D0.5) and 0.93 (D0.1) for PC3 cell lines respectively. For the first time, this study has shown that 154 MeV electrons can be used to effectively kill lung and prostate cancer cells, suggesting that VHEE would be a viable radiotherapy modality. Several studies have shown that VHEE has characteristics that would offer significant improvements over conventional photon radiotherapy for example, electrons are relatively easy to steer and can be used to deliver dose rapidly and with high efficiency. Studies have shown improved dose distribution with VHEE in treatment plans, in comparison to VMAT, indicating that VHEE can offer improved and safer treatment plans with reduced side effects. The biological response of cancer cells to VHEE has not been sufficiently studied as of yet, however this initial study provides some initial insights into cell damage. VHEE offers significant benefits over photon radiotherapy and therefore more studies are required to fully understand the biological effectiveness of VHEE.

3357: Impact of deformable image registration uncertainties for external beam radiotherapy applications

3357: Impact of deformable image registration uncertainties for external beam radiotherapy applications

Photon Shielding Capability of Concrete Doped with FeO for Radiotherapy Application

Photon Shielding Capability of Concrete Doped with FeO for Radiotherapy Application

Radioluminescence-based fibre-optic dosimeters in radiotherapy: a review

Since their conception in the early 1990s, radioluminescence-based fibre-optic dosimeters (FODs) have attracted great interest for dosimetric applications in radiotherapy (RT). Over the years, many scintillating materials, both organic and inorganic, have been developed and tested by multiple research groups around the world. In parallel, reliable techniques for removing or subtracting the stem effect, one of the main drawbacks of FODs, have been proposed in the literature. To date, several prototype systems are widespread, some of which prove to be viable commercial solutions. This review aims to trace the efforts over the years that have enabled FODs to become reliable tools for dosimetry in the current RT procedures and promising options for future scenarios. After a first section devoted to a thorough discussion of the stem effect issue, the use of FODs in various applications of interest to RT, primarily small-field dosimetry and in vivo dosimetry, are addressed. Their use both in external beam RT, including hadrontherapy, and in brachytherapy are considered. A special focus is given to the peculiarities of MRI LINAC dosimetry and the contributions of FODs in this context. Finally, the state of the art concerning the development and characterization of FODs for monitoring ultra-high dose rate radiation beams, typical of FLASH therapy and microbeam RT are presented, highlighting the challenges still open.

Analysis of the molecular alterations in cancer cells following nanotechnology-assisted targeted radiotherapy using Raman spectroscopy

The study unveiled an innovative strategy for precise radiation targeting in cancer treatment, along with the monitoring of molecular changes induced by this therapeutic approach. In this research, we explored the impact of administering anti-HER2-AgNPs nanoconjugates either individually or in conjunction with gamma irradiation on the viability of SKBR3 breast cancer cells. The utilization of nanoconjugates resulted in an enhancement of cellular sensitivity toward radiation. The viability of the cells exhibited a decline as the dose of irradiation increased, and this decrease was further exacerbated by the passage of time following irradiation. The analysis of RS revealed distinct cellular responses in varying conditions. The observed increase in SERS intensity, resulting from the increment in dose from 0 to 2 Gy, can be attributed to the probable upregulation of HER2 expression induced by irradiation. The observed decrease in SERS intensity at doses of 4 and 6 Gy can be attributed to the likely reduction in HER2 expression. It was illustrated that the analysis of Raman spectroscopy data can aid in the identification of radiation-induced biochemical alterations in cancer cells during the application of nanoconjugates-based radiotherapy. The findings revealed that nanoconjugates have the potential to enhance cellular sensitivity to radiation along with facilitating the detection of radiation-induced biochemical alterations within cancer cells.